Effects Of Non-surgical Periodontal Therapy On Systemic Inflammation And Metabolic Markers In Patients Undergoing Haemodialysis And/or Peritoneal Dialysis

Background: End-stage renal disease(ESRD)is a disease that seriously affects the whole body,and inflammation plays an important role in the occurrence and development of ESRD.Dialysis is the most commonly used life-sustaining treatment for patients with ESRD.Chronic periodontitis(CP)is an inflammatory disease caused by plaque infection,which is related to systemic inflammation.It may aggravate the existing systemic inflammation in dialysis patients,resulting in an increased risk of poor prognosis in dialysis patients.Therefore,it is speculated that CP is one of the preventable and potential determinants of the source of inflammation in dialysis patients.In recent years,non-surgical periodontal therapy(NSPT)has become the standard therapy of periodontitis and is widely used in the treatment of periodontitis in patients with systemic diseases.The use of NSPT in ESRD patients receiving dialysis in several studies has been found that NSPT can not only improve the periodontal status ofpatients,but also have certain effects on systemic inflammation,nutrition and lipid metabolic markers.However,there is still controversy about this point.In order to solve the above clinical problems,we selected randomized controlled clinical trials(RCTs)for systematic review and meta-analysis to explore the effects of periodontal treatment on systemic inflammation and metabolism in ESRD patients receiving dialysis.Aim: This systematic review aimed to investigate whether NSPT can reduce systemic inflammatory levels and improve metabolic parameters in patients undergoing haemodialysis(HD)and/or peritoneal dialysis(PD).Methods: Electronic databases(PubMed,EMBASE,CENTRAL,CNKI,and Wanfang Data)were searched for randomized controlled trials(RCTs)performed through July 2019.The risk of bias within studies was assessed with the Cochrane Collaboration's risk assessment tool.The systemic inflammatory and metabolic outcomes included the highly sensitive C-reactive protein(hs-CRP),interleukin 6(IL-6),tumour necrosis factor-?(TNF-?),the albumin(Alb),and lipid metabolite levels.Meta-analyses(MAs)were performed to calculate the overall effect size where appropriate.Results: Five RCTs were included in this study.Compared with untreated periodontitis groups,the dialysis patients after NSPT significantly showed decreased hs-CRP levels from 4-to 8-weeks(standardized mean difference:-1.53,95% confidence interval-2.95 to-0.11,P<0.05).No significant difference was found in IL-6 and Alb levels following NSPT at either the 3-or 6-month follow-ups.No MAs could be performed on the TNF-? level and the lipid metabolic markers.Conclusions: NSPT can significantly reduce serum hs-CRP levels in HD and/or PD patients,but did not change IL-6 or Alb levels.For TNF-?and lipid metabolism markers,no sufficient evidence supports that these levels are changed after NSPT.Additional scientific research is necessary to assess the effects of NSPT on systemic inflammation and metabolic parameters in dialysis patients.